Nurse exodus plagues Philippines
By Patricia Adversario

MANILA - The top-notch performance of Filipino nurses during the current severe acute respiratory syndrome (SARS) crisis was duly noted at a recent regional summit on the epidemic. But the plaudits ironically drew attention to another illness plaguing the Philippines - the exodus of its best nurses.

Many Filipino nurses, Chinese and Singaporean authorities told Philippine President Gloria Macapagal-Arroyo at the summit, had cut their vacations short because they said their host societies needed them to deal with the rising cases of people with the pneumonia-like SARS.

That Filipino overseas workers or immigrants are appreciated in the more than 100 countries where they work is a refrain often heard in the Philippines, a country of 80 million people said to be the world's largest organized exporter of human labor. But the irony is particularly painful in the case of Filipino nurses - of which nearly 14,000, or some say much more - leave each year for better pay and opportunities.

Despite the high quality of the training they receive in the Philippines, health professionals there are poorly paid. In fact, even specialist doctors in that country have been enrolling in nursing schools so they can qualify for nursing jobs overseas that pay many times what they could earn as doctors in their homeland.

The costs of this migration are being felt in this poor country that needs its best health professionals but spends thousands of dollars training each nurse - only to have them serve the needs of countries like Britain, the United States, Saudi Arabia and Ireland.

"Sadly, this is no longer brain drain, but more appropriately, brain hemorrhage of our nurses," said Dr Jaime Galvez Tan, vice chancellor for research at the University of the Philippines in Manila, and executive director of the National Institutes of Health Philippines. "Very soon, the Philippines will be bled dry of nurses."

Rose Gonzalez is a nursing graduate turned public relations practitioner for seven years, but who is now again a nurse, is leaving soon to work at the Johns Hopkins University Hospital in Maryland in the United States.

She is among the Filipino nurses who find their profession the sure ticket to a better-paying job abroad - and the shortest route to obtaining immigrant status elsewhere.

Government figures report that 2,908 Filipino nurses left for 21 countries in the first quarter of 2002. In the previous year, 13,536 nurses left for 31 countries.

The Philippine Overseas Employment Administration (POEA), which processes the departure of migrant workers, said only 304 nurses left for the United States in 2001. This figure, however, is said to be grossly underreported. The agency also does not handle nurses who leave on immigrant visas.

The Philippines is such a rich recruitment ground for nurses - and increasingly, caregivers too - that US-based hospitals hold nursing job fairs in the country. The International Union of Nurses says close to 10,000 nurses were directly hired in this manner in 2001.

Tan says the annual outflow of Filipino nurses is now three times the annual production of licensed nurses of 6,500-7,000 year.

Because of the demand created by the aging of populations in the industrialized world in the next 10-15 years, Tan said: "It will no longer be the roller-coaster demand for foreign graduate nurses seen in the last 35 years. This time, it will be a persistent, chronic need." The solution for these countries: hire foreign nurses to do the job. The United States has said it would need about 10,000 nurses a year, while Britain, Ireland, the Netherlands and other European countries would need another 10,000 nurses a year.

Austria and Norway have announced their need for foreign nurses this year and Japan, a new market, is expected to open its doors to foreign nurses this year.

Concern is also rising about a shortage of nurses in the Philippines. "In absolute terms, there is no shortage. There are enough warm bodies here, but there is a shortage in terms of quality," said Dr Marilyn E Lorenzo, director of the Institute of Health Policy and Development Studies and professor at the University of the Philippines College of Public Health.

The ones who have left are the skilled and experienced nurses. Most of those still here are relatively unskilled and inexperienced, and go overseas after a year or two of gaining experience. This poses serious implications for the quality of health care that they provide.

The government is the single biggest employer of nurses and pays better than private hospitals, but it has not opened new positions and average nurse-to-patient ratios are far from ideal - 1:30-1:60.

Maria Linda Buhat, president of the Association of Nursing Service Administrators of the Philippines, says nurses go overseas because of the low salary at home, lack of professional opportunities, adventure, family ties, citizenship and health reasons.

Overseas, the monthly pay ranges from US$3,000-$4,000 a month, compared with the $169 average pay in most Philippine cities. In rural areas, nurses receive from $75-$95 a month.

Lydia Vengzon, who worked as nursing director for years, recalls an exit interview with one of her nurses, who was leaving for Britain to take on a new job for $2,884 a month. "In all my 31 years as nursing director, my salary didn't even reach a third of that amount."
Virginia Alinsao, director of international nursing recruitment of the Johns Hopkins Health System, recalls how one young nurse applicant she interviewed in Manila in April said her mother had worked as a nursing assistant in Saudi Arabia since she was five years old. "The applicant said she wanted her mother to rest. Working as a nurse here won't allow her to do that," related Alinsao.

Alinsao herself left the Philippines when she was 22 and has been in the United States for 30 years. From her class batch of 50, only five have worked as nurses in the Philippines. Most of them, like her, have since become US citizens.

She notes with amazement how even Filipino doctors have been studying to become nurses, a reverse human resource development phenomenon that she thinks is found only in this country.

Specialist doctors have also been enrolling in nursing schools to take advantage of immigration visas offered to nurses who apply to work in the United States. Doctors in the Philippines earn an average income of $300-$800 a month, a pittance compared with the salary of a nurse in the United States or Europe.

(Inter Press Service)